CHANGE MANAGEMENT

Change is hard and a little messy at first, but at the end, it may be more beautiful than you expected. Changes in life are not jokes, they should be taken seriously. Same as changes in the laboratory, one little change could bring everything down. Here is a brief info on how to manage a change in the laboratory.

Change management is the discipline that guides how we prepare, equip and support individuals to successfully adopt change in order to drive organizational success and outcomes. Decades of research shows there are actions we can take to influence people in their individual transitions. Change management provides a structured approach for supporting the individuals in your organization to move from their own current states to their own future states.

There are 3 levels of Change Management:

The first level is the Individual Change Management. This requires understanding how people experience change and what they need to change successfully. It also requires knowing what will help people make a successful transition such as what messages do people need to hear, when and from whom; when the optimal time to teach someone a new skill is; how to coach people to demonstrate new behaviors; what makes changes “stick” in someone’s work.

Second is the Organizational / Initiative Change Management. This involves first identifying the groups and people who will need to change as the result of the project, and in what ways they will need to change.

The third level is the Enterprise Change Management Capability. The organizational core competency that provides competitive differentiation and the ability to effectively adapt to the ever-changing world. It means effective change management is embedded into your organization’s roles, structures, processes, projects and leadership competencies.

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new”    

- Socrates

HOW TO BE SAFE IN THE LABORATORY

No job is so important and no service is so urgent that we cannot take time to perform our work safely. Being safe is a must in being a medical technologist. Safety saves us from different hazards and infections. There are a lot of safety reminders in the laboratory, some of them are as follows:

• The observance of the Material Safety Data Sheet (MSDS)
• The MSDS is a document detailing the safety information about each hazardous substance must be available to employees at all times in an obvious and easily accessible location.
• The proper handling of biological specimens
• Tissues, organs, mucous secretions, saliva, semen, vaginal, urethral, cavity fluids, exudates, wounds, amniotic fluid and any materials acquired from the body are likely to be contaminated with blood and will invariably carry blood-borne pathogens.
• The practice of fire prevention
• Fire-fighting start firstly in the layout of the building plan. Materials used for the construction of the lab and actual construction require that fire-resistance should be at accepted available standards of safety. The devices that fight fires must be laid in plans.

The possible health and mechanical hazards that can be met inside the lab are:

• Compressed gases
• Electric shock
• Toxic vapors and irritants
• Flammable liquids
• Radioactive materials
• Corrosive substances
• Mechanical trauma
• Poisons
• Biologic materials
• Cryogenic materials
• Toxic and highly toxic agents
• Reproductive toxin
• Carcinogen
• Irritant
• Tissue corrosive
• Sensitizer
• Liver, kidney, and nervous system toxins
• Agents that act on or damage other body systems: hematopoietic, lungs, skin, eyes, mucous membranes

The Protective Methods and Procedures for the Laboratory

• Universal Precautions
• “Treat all human blood and certain human body fluids as if they were known to be infectious”
• Engineering and Work Practice Control
• “Engineering controls isolate or remove the blood-borne pathogen hazard from the workplace. Work practice controls reduce the likelihood of exposure by altering the manner in which a task is performed. Administrative controls include education, training, and application of Standard Operating Procedures for preventing occupational exposure to blood and other potentially infectious fluids.”
• Personal Protective Equipment
• Housekeeping Techniques
• Waste disposal system

Safety codes that help maintain the safety of the workplace

• Occupational Safety and Health Act
• RA 9003 (The Ecological Solid Waste Management Act of 2000)
• RA 6969 (Toxic Substances and Hazardous and Nuclear Wastes Control Act of 1990)
• RA 8749 (Philippine Clean Air Act)
• RA 9275 (The Philippine Clean Water Act of 2004)

“Safety is not an intellectual exercise to keep us in work. It is a matter of life and death. It is the sum of our contributions to safety management that determines whether the people we work with live or die.”                              

- Sir Brian Appleton, Safety Assessor

FUNCTIONS OF MANAGEMENT

PLANNING

• Attempt to anticipate the future and either shape it to their own ends or prepare for the coming changes.
• Thinking and analyzing portion of management process.
• Foundation of management

ORGANIZING

• Process of studying activities, materials and personnel for accomplishing pre-determined objectives.
• Knowing the task, understanding what knowledge and expertise the employees must process.
• Understanding the physical and capital requirement that must be assembled.

DIRECTING

• Process in supervising
• Leading worker to accomplish goals
• Seeing that day tasks are done
• Influencing people’s behavior through motivation, communication, group dynamics, leadership and discipline.

CONTROLLING

• Process of checking up on the priorities established
• Competes the management function loop by comparing what has actually been accomplished
• Standards the performance of people and process are set, communicated and applied

LEVELS OF MANAGEMENT

TOP LEVEL OF MANAGEMENT

• Consists of board of directors, chief executive or managing director.
• The top level is the ultimate source of authority and it manages goals and policies for an enterprise.
• It devotes more time in planning and coordinating functions.
• It controls and coordinates the activities of all departments.
• Responsible for maintaining a contact with the outside world.
• Provides guidance and direction.
• Responsible towards the shareholders for the performance of enterprise.

MIDDLE LEVEL OF MANAGEMENT

• Branch of managers and departmental managers.
• Organizational and directional functions.
• Execute the plans on the organization in accordance with the policies and directives of the top management.
• Make plans for the sub-units of the organization.
• Participate in employment and training of lower management.
• Interpret and explain policies from top level.

LOWER LEVEL OF MANAGEMENT

• a.k.a supervisory/operative level of first line of management, consist of supervisors, foreman, section officers, superintendent.
• Directing and controlling functions.
• Assigning of jobs and tasks to various workers.
• They guide and instruct workers for day to day activity responsible for the quality as well as quantity of production.
• They are also entrusted with the responsibility of maintaining good relation on the organization

TYPES OF LABORATORIES

OPEN LAB

• routine procedures in different sections in the lab are located only in large room

CLOSED LAB

• different sections the lab are located in separate room; e.g. AUFMC

REFERENCE LAB

• can handle all types of testing
• traditional full service lab

POCT LAB

• lab testing is brought to the patient’s bedside.
• one of the major lab tests offered is RBC monitoring.

STAT LAB

• provides rapid results for critical lab tests such as HCTs and blood gases.
• performs stat tests but special tests are sent to an off-site lab.
• often located in or near emergency rooms and operating rooms.

SATELLITE LAB

• located throughout a hospital.
• decentralization of lab services to respond quickly to a department’s special needs
• “mini” versions of chem, hema, and microscopy sections.
• may be located in surgery department, critical care units, off-site clinics and out patient’s clinic.

QUALITY CONTROL

Quality Control relies heavily on quantitative statistical methods that focus on the final product, as defined by standards set by the producer.

TYPES OF QUALITY CONTROL

• Internal Quality Control - Monitors the day-to-day performance of lab test, namely precision.
• External Quality Control - Monitors primarily the accuracy of lab tests

LAB PRACTICES ON QUALITY CONTROL

Division of Lab Practice in QC

• Preventive Procedures - pre-analytic activities that are intended to establish a system which leans towards providing accuracy.These preventive measures include performance checks and calibration of equipment, examination of user-prepared and commercially-prepared media and orientation and training of lab staff
• Assessment Practices - analytic activities that are done during the test to determine whether the established systems are performing correctly. The use of standards and controls, as well as control chart maintenance is included in the assessment practices.
• Corrective Practices - post-analytic activities to determine error and possible sources of error to be able to correct the established system. Activities in the corrective practices include troubleshooting of equipment used, recalibration of instruments, retraining of staff, etc.

Control of Tests

• Precision – It can be assessed intra-laboratory and inter-laboratory. It is determined by how well a procedure reproduces a value.
• Accuracy – commonly known as the “gold standard” if refers to the closeness of a result to the actual value of an analyte when performing a test.
• Sensitivity – is the percentage of individuals with particular disease for which the test is used in whom positive results are found.
• Specificity – is the percentage of individuals who do not have the particular disease and whom negative results are found.

Control of Specimens

These instructions should be available to the hospital staff for use when specimens are collected. The written collection instructions should include:

• Test purpose and limitation
• Patient selection criteria
• Timing of specimen collection
• Optimal specimen collection sites
• Approved specimen collection methods
• Specimen transport medium, time and temperature
• Availability of test
• Hours test performed
• Result reporting procedures

Control of Reagents and Supplies

• Labs should purchase reagents and supplies from reliable sources
• Containers of reagents should be labeled as to contents, concentration, date opened, expiration date, source, lot number, and storage requirements
• All supplies and reagents should be stored according to manufacturer’s recommendations
• Tested with positive and negative controls before use
• No incidence of lack of supplies for the lab tests offered
• First in, first out must always be followed
• Outdated supplies and reagents that failed QC should be discarded immediately

Control of Staff

Appropriately trained and experienced personnel are essential for the performance of quality laboratory testing. All employees should know what they are supposed to do, and every laboratory should have written job descriptions to provide them. Standards of performance should be developed so that the employee knows how he will be judged when rated on job performance.

Control of Equipment

Equipment and instrument logs should contain the following information:

• Equipment or instrument name; serial number and date 
• Procedure and periodicity for routine function checks
• Acceptable performance ranges
• Instrument function failures, including specific details of steps taken for corrective action
• Date and time of service request and response
• Date of routine preventive maintenance which should follow manufacturer’s recommendations

PERSONNEL MANAGEMENT

PERSONNEL MANAGEMENT is concerned with the effective use of the skills of people. They may be salespeople in a store, clerks in an office,operators in a factory, or technicians in a research laboratory. It starts with the recruiting and hiring of qualified people and continues with directing and encouraging their growth as they encounter problems and tensions that arise in working toward established goals.

PERSONNEL SELECTION PROCESS
Personnel selection is the process used to hire individuals. It is the methodical placement of individuals into jobs. The process of selection follows a methodology to collect information about an individual in order to determine if that individual should be employed. The methodology used should not violate any laws regarding job positions are.

Minimum criteria used to define job positions are:

• Minimum education
• Experience
• Licensure examination
• Posting or advertising job vacancies
• Reception of applications or applicants either in person or in writing
• Preliminary interview
• Performance tests
• Intelligence tests
• Aptitude tests
• Interest tests
• Test of emotional reaction/and adjustments